Poll Worker Application - Rutherford County, TN

Name *

Voter #

SSN

Date of Birth

Address *

Cell Phone

Do you use text messaging? Yes
No

Home Phone

Email

Political Party Affiliation Democrat
Republican
Independent

Party Balance - The state requires party balance at all polling sites. We staff an equal number of Democratic and Republican workers at each site.

Do you have a valid TN Driver's License & reliable means of transportation to and from the polls? Yes
No

Do you have computer experience? Yes
No

Employment Status: Full-Time
Part-Time
Military
Unemployed
Retired

Where are you currently employed (if applicable)?

Do you have problems SITTING for long periods of time? Yes
No

Do you have problems STANDING for long periods of time? Yes
No

Are you currently employed by a Federal, State, or Local Government Agency? Yes
No

TN Code Ann. 2-1-112 - Tennessee law prohibits government employees from serving as election officials EXCEPT any employee of a county or city school system or a Tennessee State Employee who does not work for an elected official.

Have you ever been convicted of a felony? Yes
No

Have you ever worked as an Election Official? Yes
No

Previous Election Worker Experience (if applicable)

Are you available to work the following dates for the 2024 Election Cycle?

Thursday, August 1, 2024 Yes
No

Tueday, November 5, 2024 Yes
No

Positions Needed: (please indicate your preference) Registrar
Machine Operator
Other...

I hereby certify that the information provided above is true and accurate Yes

Date of Application